This appeal arises pursuant to the Texas Workers’ Compensation Act, Tex. Lab. Code Ann. § 401.001 et seq. (1989 Act). A contested case hearing was held on November 5, 2025, with the record closing on November 6, 2025, in (city), Texas, with (administrative law judge) presiding as the administrative law judge (ALJ). The ALJ resolved the disputed issues by deciding that: (1) the compensable injury of (date of injury), extends to right shoulder adhesive capsulitis and right shoulder tendinosis; (2) the appellant (claimant) reached maximum medical improvement (MMI) on December 30, 2024; and (3) the claimant’s impairment rating (IR) is 4%.
The claimant appealed, disputing the ALJ’s determinations of MMI and IR. The respondent (carrier) responded, urging affirmance of the disputed determinations.
The ALJ’s determination that the compensable injury of (date of injury), extends to right shoulder adhesive capsulitis and right shoulder tendinosis was not appealed and has become final pursuant to Section 410.169.
DECISION
Affirmed in part and reversed and rendered in part.
The parties stipulated, in part, that on (date of injury), the claimant sustained a compensable injury that extends to at least a right shoulder strain and the Texas Department of Insurance, Division of Workers’ Compensation (Division) appointed (Dr. W) as designated doctor to address extent of injury, MMI, and IR. The claimant, a sonographer, testified she injured her right shoulder while scanning a patient.
MMI
The ALJ’s determination that the claimant reached MMI on December 30, 2024, is supported by sufficient evidence and is affirmed.
IR
Section 408.125(c) provides that the report of the designated doctor shall have presumptive weight, and the Division shall base the IR on that report unless the preponderance of the other medical evidence is to the contrary, and that, if the preponderance of the medical evidence contradicts the IR contained in the report of the designated doctor chosen by the Division, the Division shall adopt the IR of one of the other doctors. 28 Tex. Admin. Code § 130.1(c)(3) (Rule 130.1 (c)(3)) provides, in part, that the assignment of an IR for the current compensable injury shall be based on the injured employee’s condition as of the MMI date considering the medical record and the certifying examination.
The ALJ determined that the claimant reached MMI on December 30, 2024, with a 4% IR as certified by the designated doctor, Dr. W on March 31, 2025. The claimant contends on appeal that Dr. W’s IR calculation contains errors and cannot be adopted.
Dr. W examined the claimant on March 27, 2025, and used the Guides to the Evaluation of Permanent Impairment, fourth edition (1st, 2nd, 3rd, or 4th printing, including corrections and changes as issued by the American Medical Association prior to May 16, 2000) (AMA Guides) to rate the compensable conditions of right shoulder sprain, right shoulder tendinosis, and right shoulder adhesive capsulitis. Dr. W based the IR on range of motion (ROM) deficits in the right shoulder. His narrative report states that he assigned 1% upper extremity (UE) impairment for 65° of flexion, 1% UE impairment for 32° of extension, 1% UE impairment for 65° of abduction, 1% UE impairment for 16° of adduction, 1% UE impairment for 70° of internal rotation, and 1% UE impairment for 29° of external rotation. Dr. W added the UE impairments to total 6% UE impairment which he converted to a 4% whole person impairment (WPI). However, as noted by the claimant in her appeal, Dr. W made several calculation errors. Figure 38 on page 3/43 of the AMA Guides provides that 65° of flexion results in either 7% UE impairment or 8% UE impairment depending on how it is rounded, not 1% UE impairment as calculated by Dr. W. Additionally, Figure 41 on page 3/44 of the AMA Guides provides that 65° of abduction results in either 5% UE impairment or 6% UE impairment depending on how it is rounded, not 1% UE impairment as calculated by Dr. W.
The Appeals Panel has previously stated that, where the certifying doctor’s report provides the component parts of the rating that are to be combined and the act of combining those numbers is a mathematical correction which does not involve medical judgment or discretion, the Appeals Panel can recalculate the correct IR from the figures provided in the certifying doctor’s report and render a new decision as to the correct IR. See Appeals Panel Decision (APD) 240162, decided March 27, 2024, and APD 171766, decided September 7, 2017. In this case, rounding the UE impairments for flexion and abduction requires medical discretion, so we cannot recalculate the IR. Therefore, we reverse the ALJ’s determination that the claimant’s IR is 4%.
There are four other certifications of MMI and IR in evidence. (Dr. B), a doctor selected by the treating doctor to act in his place, examined the claimant on January 30, 2025, and certified the claimant reached MMI on December 30, 2024, with a 10% IR based on the conditions of right shoulder sprain and adhesive capsulitis. As this certification does not consider or rate the compensable condition of right shoulder tendinosis, it cannot be adopted.
(Dr. S), the carrier-selected required medical examination doctor, examined the claimant on October 7, 2025, and certified the claimant reached MMI on December 30, 2024, with a 4% IR based on the compensable conditions. Regarding the IR, Dr. S stated in his report that the most accurate ROM measurements were obtained as of March 27, 2025, which is the exam of Dr. W as discussed above. Dr. S used the incorrectly calculated IR by Dr. W, which we have determined cannot be adopted.
(Dr. K), a doctor selected by the treating doctor to act in his place, examined the claimant on October 21, 2025, and certified the claimant reached MMI on July 18, 2025, with an 11% IR based on the compensable conditions. As we have affirmed the ALJ’s determination that the claimant reached MMI on December 30, 2024, this certification cannot be adopted.
In evidence is a request for a letter of clarification from the claimant to Dr. W dated June 18, 2025, requesting him to correct the IR miscalculations that were discussed above. Dr. W responded with a corrected report on July 10, 2025. The new report certified the claimant reached MMI on December 30, 2024, with an 11% IR. The amended certification by Dr. W rated the compensable injury in accordance with the AMA Guides and is supported by the evidence. Accordingly, we render a new decision that the claimant’s IR is 11%.
SUMMARY
We affirm the ALJ’s determination that the claimant reached MMI on December 30, 2024.
We reverse the ALJ’s determination that the claimant’s IR is 4% and render a new decision that the claimant’s IR is 11%.
The true corporate name of the insurance carrier is AIU INSURANCE COMPANY and the name and address of its registered agent for service of process is
CORPORATION SERVICE COMPANY
211 EAST 7TH STREET, SUITE 620
AUSTIN, TEXAS 78701-3218.
Cristina Beceiro
Appeals Judge
CONCUR:
Carisa Space-Beam
Appeals Judge
Margaret L. Turner
Appeals Judge